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Ripollés-Melchor J, Aldecóa C, Lorente JV, Ruiz-Escobar A, Monge-García MI, Jiménez I, Jover-Pinillos JL, Galán-Menendez P, Tomé-Roca JL, Fernández-Valdes-Balgo P, Colomina MJ. Fluid challenges in operating room: A planned sub study of the Fluid Day observational study. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:311-318. [PMID: 37276966 DOI: 10.1016/j.redare.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/21/2022] [Indexed: 06/07/2023]
Abstract
BACKGROUND Intraoperative fluid administration is a ubiquitous intervention in surgical patients. But inadequate fluid administration may lead to poor postoperative outcomes. Fluid challenges (FCs), in or outside the so-called goal-directed fluid therapy, allows testing the cardiovascular system and the need for further fluid administration. Our primary aim was to evaluate how anesthesiologists conduct FCs in the operating room in terms of type, volume, variables used to trigger a FC and to compare the proportion of patients receiving further fluid administration based on the response to the FC. METHODS This was a planned substudy of an observational study conducted in 131 centres in Spain in patients undergoing surgery. RESULTS A total of 396 patients were enrolled and analysed in the study. The median [interquartile range] amount of fluid given during a FC was 250ml (200-400). The main indication for FC was a decrease in systolic arterial pressure in 246 cases (62.2%). The second was a decrease in mean arterial pressure (54.4%). Cardiac output was used in 30 patients (7.58%), while stroke volume variation in 29 of 385 cases (7.32%). The response to the initial FC did not have an impact when prescribing further fluid administration. CONCLUSIONS The current indication and evaluation of FC in surgical patients is highly variable. Prediction of fluid responsiveness is not routinely used, and inappropriate variables are frequently evaluated for assessing the hemodynamic response to FC, which may result in deleterious effects.
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Affiliation(s)
- J Ripollés-Melchor
- Department of Anesthesia and Critical Care, Hospital Universitario Infanta Leonor, Madrid, Spain; Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Spain.
| | - C Aldecóa
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Spain; Department of Anesthesiology and Surgical Critical Care, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - J V Lorente
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Spain; Department of Anesthesia and Critical Care, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - A Ruiz-Escobar
- Department of Anesthesia and Critical Care, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - M I Monge-García
- Department of Anesthesia and Critical Care, Hospital Universitario Infanta Leonor, Madrid, Spain; Edwards Lifesciences, Irvine, California, United States
| | - I Jiménez
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Spain; Department of Anesthesia, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J L Jover-Pinillos
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Spain; Department of Anesthesia, Hospital Verge dels Lliris, Alcoy, Alicante, Spain
| | - P Galán-Menendez
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Spain; Department of Anesthesia, Hospital Universitario Vall d'Hebrón, Barcelona, Spain
| | - J L Tomé-Roca
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Spain; Department of Anesthesia, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - P Fernández-Valdes-Balgo
- Department of Anesthesia and Critical Care, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - M J Colomina
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Spain; Department of Anesthesia and Critical Care, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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Ripollés-Melchor J, Colomina MJ, Aldecoa C, Alonso-Cabello J, Alonso-Íñigo JM, Aya H, Basora M, Clau-Terre F, Del Cojo-Peces E, Cota-Delgado F, Ferrandis-Comes R, Galán-Menéndez P, García-López D, Garruti I, López IJ, Jover-Pinillos JL, Llau-Pitarch JV, Lorente JV, Mesquida J, Mojarro I, Monge-García MI, Montesinos-Fadrique SC, Muñoz-Rodes JL, de Nadal M, Ramasco F, Tomé-Roca JL, Pérez A, Uña-Orejón R, Yanes G, Zorrilla-Vaca A, Escarraman D, García-Fernández J. Research priorities in perioperative fluid therapy and hemodynamic monitoring: A Delphi Consensus Survey from the Fluid Therapy and Hemodynamic Monitoring Subcommittee of the Hemostasis, Transfusion Medicine and Fluid Therapy Section (SHTF) of the Spanish Society of Anesthesiology and Critical Care (SEDAR). Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:319-326. [PMID: 37279834 DOI: 10.1016/j.redare.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/23/2022] [Indexed: 06/08/2023]
Abstract
BACKGROUND Research in fluid therapy and perioperative hemodynamic monitoring is difficult and expensive. The objectives of this study were to summarize these topics and to prioritize these topics in order of research importance. METHODS Electronic structured Delphi questionnaire over three rounds among 30 experts in fluid therapy and hemodynamic monitoring identified through the Fluid Therapy and Hemodynamic Monitoring Subcommittee of the Hemostasis, Transfusion Medicine and Fluid Therapy Section of the Spanish Society of Anesthesiology and Critical Care. RESULTS 77 topics were identified and ranked in order of prioritization. Topics were categorized into themes of crystalloids, colloids, hemodynamic monitoring and others. 31 topics were ranked as essential research priority. To determine whether intraoperative hemodynamic optimization algorithms based on the invasive or noninvasive Hypotension Prediction Index versus other management strategies could decrease the incidence of postoperative complications. As well as whether the use of renal stress biomarkers together with a goal-directed fluid therapy protocol could reduce hospital stay and the incidence of acute kidney injury in adult patients undergoing non-cardiac surgery, reached the highest consensus. CONCLUSIONS The Fluid Therapy and Hemodynamic Monitoring Subcommittee of the Hemostasis, Transfusion Medicine and Fluid Therapy Section of the Spanish Society of Anesthesiology and Critical Care will use these results to carry out the research.
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Affiliation(s)
- J Ripollés-Melchor
- Hospital Universitario Infanta Leonor, Madrid, Spain; Spanish Perioperative Audit and Research Network (ReDGERM), Spain; Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain.
| | - M J Colomina
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain; Universidad de Barcelona, Barcelona, Spain
| | - C Aldecoa
- Spanish Perioperative Audit and Research Network (ReDGERM), Spain; Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Hospital Universitario Río Hortega, Valladolid, Spain
| | | | | | - H Aya
- St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - M Basora
- Hospital Clínico de Barcelona, Barcelona, Spain
| | - F Clau-Terre
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - E Del Cojo-Peces
- Hospital Área de Salud Don Benito y Villanueva, Don Benito, Badajoz, Spain
| | - F Cota-Delgado
- Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | | | | | - D García-López
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - I Garruti
- Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - I J López
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J L Jover-Pinillos
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Hospital Universitario Virgen de los Lirios, Alcoy, Alicante, Spain
| | | | - J V Lorente
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - J Mesquida
- Parc Taulí Hospital Universitari, Sabadell, Barcelona, Spain
| | - I Mojarro
- Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - M I Monge-García
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Hospital Universitario Jerez de la Frontera, Jerez de la Frontera, Cádiz, Spain
| | - S C Montesinos-Fadrique
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Independent Researcher, Córdoba, Spain
| | | | - M de Nadal
- Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - F Ramasco
- Hospital Universitario La Princesa, Madrid, Spain
| | - J L Tomé-Roca
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - A Pérez
- Hospital Universitario de Elche, Elche, Alicante, Spain
| | | | - G Yanes
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Hospital Universitario Virgen de los Lirios, Alcoy, Alicante, Spain
| | - A Zorrilla-Vaca
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Brigham and Women's Hospital, Boston, United States
| | - D Escarraman
- Centro Médico Nacional La Raza, Mexico City, Mexico
| | - J García-Fernández
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Critical Care (SEDAR), Spain; Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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